Essential Elements of the Care Groups Approach Moderator: Mary DeCoster, TOPS Senior Specialist for SBC, Food for the Hungry

Presenters: Sarah Borger, Director of Health and Nutrition Programs, Food for the Hungry Geoffrey Arijole Nyakuni, Food for the Hungry, Democratic Republic of Congo Ryan Larrance, Independent Consultant

What are Care Groups? A community based strategy for improving coverage and behavior change, focus is primarily maternal and child health and reducing malnutrition

Care Group Structure

Who is Using Care Groups? International Aid International Medical Corps International Rescue Committee Living Water International Medair Medical Teams International Pathfinder PLAN Project Concern International Salvation Army World Service Save the Children World Renew World Relief World Vision

ACDI/VOCA ADRA Africare American Red Cross CARE Concern Worldwide Catholic Relief Services Curamericas Emmanuel International Feed The Children Food for the Hungry Future Generations GOAL

Where are Care Groups being Used? Bangladesh Bolivia Burkina Faso Burundi Cambodia DRC Ethiopia Guatemala Haiti Indonesia Kenya Liberia Malawi Mexico Mozambique

Nicaragua Niger Peru Philippines Senegal Rwanda Sierra Leone Somalia South Sudan Sudan Uganda Zambia Zimbabwe

GAME

ATTENDANCE & TROUBLESHOOTING

ASK ABOUT CURRENT PRACTICES

FACILITATION: behavior change promotion through story and pictures

ACTIVITY

DISCUSSING BARRIERS

PRACTICE AND COACHING

MAKING A COMMITMENT

Sarah Borger

Care Group Criteria and Checklist

Geoffrey Arijole Nyakuni

Care Groups Experience in the Democratic Republic of Congo

Challenges to implementation of CGs in DRC

• Population movement in relation to Agricultural seasons

• Internal displacement of populations due to tribal and/or armed conflicts

• Management of promoter to ML rations in sparsely populated conditions

• Poor infrastructure – roads and health services

Challenges –cont’d

• Low literacy among the mothers and population in general

• Number of languages and dialects in which to prepare materials

• Work load on MLs due to demands placed on them by other NGOs

• Weak or non existent government structure to support CGs

• Absenteeism of MBs thus the need for follow-up thus more work for promoters

Challenges cont’d

• Challenges with motivational/identification material such as t-shirts

• Incentives given by other actors within the same intervention area

• Referral mechanisms for identified children • Lack of inputs at health facility level for

support • Relief mentality still a great hindrance in the

locations

Positives

• Interest and appreciation of their work by government staff

• Results of their work is visible in the community

• Adequate community leadership support • Flexibility in meeting times/schedules

Ryan Larrance

Care Groups Trios Approach in Bangladesh

CARE GROUP TRIO MODEL ASSESSMENT

January 27,2016 Ryan Larrance, Consultant

Background

• The Program for Strengthening Household Access to Resources (PROSHAR)

• Multi-Year Assistance Program implemented from 2010-2015 in Southwestern Bangladesh

• Disclosures

Care Group Trio Model Structure Mother CGs Meet Twice

Monthly

Grandmother CGs Meet Monthly

Father CGs Meet Bi-Monthly

Neighbor Group

Supervisor

Promoter

Graphic adapted from- Care Groups: A Training Manual for Program Design and Implementation

Assessment Methodology

•Focus group discussions • 15 FGDs, all types of CG

Trio Participants

•Key informant interviews • 12 KII, PROSHAR staff,

MoH staff, others

•Review program data • Program baseline and endline

survey, program data, BCC assessment, etc.

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Program Data: Care Group & Neighbor Group Attendance

Rates

Source: PROSHAR program data

30%40%50%60%70%80%90%

100%

MP Attendance ML Attendance FP Attendance

FL Attendance GmP Attendance GmL Attendance

Population Based Final Evaluation

• Baseline (Jan. 2011) and endline (January 2015) population based assessments conducted by TANGO International

• TANGO’s endline report states: “adoption of recommended MCHN practices...increased substantially from baseline to endline, and...adoption of most practices was significantly higher for participants than non-participants.”

Wendy Stone for PCI

Qualitative Data Findings

• Nearly all respondents believe targeting fathers and grandmothers resulted in higher adoption of behaviors

• Age and gender were an important factor in the success of the peer – to – peer communication of messages

• Having multiple people in the household (HH) educated on new behaviors helped with remembering to practice new behaviors

• Several reports of Mother Leaders (MLs), Father Leaders (FLs), and Grandmother Leaders (GmLs), working together to support behavior change in HHs slow to adopt new behaviors

Qualitative Data: Additional Findings

• FLs and GmLs increased the number of indirect program beneficiaries

• Educating the whole HH increased harmony within the HH

• CG Trio Model increased mother’s MCHN related decision making power and freedom of movement

• CG Trio Model potentially contributed to reducing domestic violence

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Final Points • The PCI team

estimated that the Trio approach cost 50% more compared to the conventional CGs

• Additional cadres (youth, grandfathers) most likely would not have added value

• The majority of respondents felt that all three cadres of CGs were required for the program to see such positive results

Wendy Stone for PCI

Resources

• Care Groups: A Training Manual for Program Design and Implementation http://www.fsnnetwork.org/care-groups-training-manual-program-design-and-implementation

• Caregroupinfo.org for modules and many other resources on Care Groups, including criteria documents

• Join the Care Group Forward online discussion group www.fsnnetwork.org or email me to join the Interest Group listserve mdecoster@fh.org